Gösta Rutger Persson

Cardiovascular disease and periodontitis : an update on the associations and risk

BACKGROUND Associations between periodontitis and cardiovascular diseases have been recognized. MATERIAL AND METHODS New literature since the last European Workshop on Periodontology has been reviewed. RESULTS The lack of reliable epidemiological data on disease prevalence makes an assessment of the associations and risks between periodontitis and cardiovascular diseases difficult. Two recent meta-analysis reports have identified associations between periodontitis and cardiovascular diseases (odds ratios: 1.1-2.2). Different surrogate markers for both disease entities, including serum biomarkers, have been investigated. Brachial artery flow-mediated dilatation, and carotid intima media thickness have in some studies been linked to periodontitis. Studies are needed to confirm early results of improvements of such surrogate markers following periodontal therapy. While intensive periodontal therapy may enhance inflammatory responses and impair vascular functions, studies are needed to assess the outcome of periodontal therapies in subjects with confirmed cardiovascular conditions. Tooth eradication may also reduce the systemic inflammatory burden of individuals with severe periodontitis. The role of confounders remain unclear. CONCLUSIONS Periodontitis may contribute to cardiovascular disease and stroke in susceptible subjects. Properly powered longitudinal case-control and intervention trials are needed to identify how periodontitis and periodontal interventions may have an impact on cardiovascular diseases.

Mechanical non‐surgical treatment of peri‐implantitis: a double‐blind randomized longitudinal clinical study. I: clinical results

BACKGROUND Peri-implantitis is a frequent finding in patients with dental implants. The present study compared two non-surgical mechanical debridement methods of peri-implantitis. MATERIAL AND METHODS Thirty-seven subjects (mean age 61.5; S.D+/-12.4), with one implant each, demonstrating peri-implantitis were randomized, and those treated either with titanium hand-instruments or with an ultrasonic device were enrolled. Data were obtained before treatment, and at 1, 3, and 6 months. Parametric and non-parametric statistics were used. RESULTS Thirty-one subjects completed the study. The mean bone loss at implants in both groups was 1.5 mm (SD +/-1.2 mm). No group differences for plaque or gingival indices were found at any time point. Baseline and 6-month mean probing pocket depths (PPD) at implants were 5.1 and 4.9 mm (p=0.30) in both groups. Plaque scores at treated implants decreased from 73% to 53% (p<0.01). Bleeding scores also decreased (p<0.01), with no group differences. No differences in the total bacterial counts were found over time. Higher total bacterial counts were found immediately after treatment (p<0.01) and at 1 week for ultrasonic-treated implants (p<0.05). CONCLUSIONS No group differences were found in the treatment outcomes. While plaque and bleeding scores improved, no effects on PPD were identified.

Clinical and microbiological analysis of subjects treated with Brånemark or AstraTech implants: a 7‐year follow‐up study

AIMS To assess the impact of different implant systems on the clinical conditions and the microbiota at implants, and whether the presence of bacteria at tooth sites was predictive of the presence at implant sites. MATERIALS AND METHODS Subjects with either AstraTech or Brånemark in function for 7 years were enrolled. Sub-gingival bacterial samples at tooth and implant sites were collected with sterile endodontic paper points, and analyzed by the checkerboard DNA-DNA hybridization method (40 species). RESULTS Fifty-four subjects, 27 supplied with AstraTech (n=132 implants) and 27 with Brånemark (n=102) implants, were studied. Test tooth sites had significantly less evidence of bleeding on probing (P<0.001) and presence of plaque (P<0.001) than implant test sites. Implant sites presented with deeper probing pocket depth than tooth sites (mean difference: 1.1 mm, standard error of differences: 0.08, 95% confidence intervals (CI): 0.9-1.3, P<0.001). Tannerella forsythia (P<0.05), Capnocytophaga sputigena (P<0.05), Actinomyces israelii (P<0.05) and Lactobacillus acidophilus (P<0.05) were found at higher levels at tooth surfaces. No differences in bacterial load for any species were found between the two implant systems. The odds of being present/absent at tooth and implants sites were only significant for Staphylococcus aureus [odds ratio (OR): 5.2 : 1, 95% CI: 1.4-18.9, P<0.01]. CONCLUSIONS After 7 years in function, implants presented with deeper probing depths than teeth. S. aureus was commonly present at both teeth and implants sites. S. aureus at tooth sites was predictive of also being present at implant sites.

Surgical treatment of peri‐implantitis using a bone substitute with or without a resorbable membrane: a 5‐year follow‐up

AIM To compare two regenerative surgical treatments for peri-implantitis over 5 years. MATERIAL & METHODS Twenty-five individuals with peri-implantitis remained at study endpoint. They were treated with a bone substitute and a resorbable membrane (13 individuals with 23 implants) [Group 1], or with bone substitute alone (12 individuals with 22 implants) [Group 2]. All study individuals were kept on a strict maintenance programme every third month. RESULTS Five-year follow-up demonstrated clinical and radiographic improvements in both groups. No implants were lost due to progression of peri-implantitis. Probing depths were reduced by 3.0 ± 2.4 mm in Group 1, and 3.3 ± 2.09 mm in Group 2 (NS). In both groups, radiographic evidence of bone gain was significant (p < 0.001). At year 5, the average defect fill was 1.3 mm (SD ± 1.4 mm) in Group 1 and 1.1 mm (SD ± 1.2 mm) in Group 2 (mean diff; 0.4 95% CI -0.3, 1.2, p = 0.24). Bleeding on probing decreased in both groups. Baseline and year 5 plaque scores did not differ between groups and was reduced from 50% to 15%. CONCLUSION Both procedures resulted in stable conditions. Additional use of a membrane does not improve the outcome.

Cytokine expression in peri-implant crevicular fluid in relation to bacterial presence

AIM The aim was to assess clinical inflammatory parameters, cytokine levels and bacterial counts in samples from implant crevicular fluid in cases with untreated peri-implantitis. MATERIAL AND METHODS Several bacterial species known to up-regulate pro-inflammatory cytokines have been associated with peri-implantitis. The Luminex magnet bead technology was used to study cytokines in crevicular fluid. The checkerboard DNA-DNA hybridization method was used to study bacterial counts in samples from 41 implants (41 individuals). RESULTS Profuse bleeding and suppuration was found in 25/41 (61.0%) of the implants. The reliability of duplicate cytokine processing was high. In the presence of profuse bleeding, higher pg/ml levels of IL-1β (p = 0.02), IL-8 (p = 0.04), TNF-α (p = 0.03) and VEGF (p = 0.004) were found. Higher concentrations of IL-1β were found in the presence of suppuration, and if Escherichia coli (p = 0.001) or Staphylococcus epidermidis (p = 0.05) could be detected. CONCLUSION Profuse bleeding and/or suppuration in untreated peri-implantitis can be associated with higher concentrations of IL-1β, IL-8, TNF-α and VEGF in peri-implant crevicular fluid. A higher concentration of IL-1β in peri-implant crevicular fluid was found in samples that were positive for E. coli or S. epidermidis.

Antibacterial activity of berry juices, an in vitro study

Abstract Objective. The aim of the present study was to evaluate in vitro antibacterial activities of blackcurrant and sea buckthorn juices on bacteria associated with gingival inflammation. Materials and methods. The growth of selected bacteria (Streptococcus mitis, Streptococcus mutans, Streptococcus sanguinis, Streptococcus gordonii, Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa) was studied in vitro on agar plates. The content of phenols in the different extracts was measured with HPLC-ESI-MS. Results. The spectrometric analysis identified that the highest level of the single phenols studied was found for ferulic acid (113 μg/ml) in blackcurrant juice. Sea buckthorn contained low levels of selected phenols. Total bacterial inhibition for all bacterial species studied was found at 20% berry juice concentration with pH varying between 4.1–5.4. Conclusions. The present study identified that in vitro bacterial growth on agar plates was inhibited by blackcurrant and sea buckthorn juices and that low juice pH explains bacterial in vitro growth. This may have clinical implications in biofilm development, reducing the risks for both tooth decay and gingivitis.

Supportive periodontal therapy for high‐ and low‐risk patients

AIM The validity of the risk assessment in predicting tooth loss due to periodontitis or disease progression was explored. METHODS Systemic factors, smoking status, bleeding on probing (BoP) percentage, number of residual pockets (probing pocket depth ≥6 mm), tooth loss, and alveolar bone loss in relation to age were the variables of the risk assessment. Based on an improving or deteriorating risk assessment in 2005 compared with 1999, 89 patients were divided into either a high- or low-risk group. Findings were compared with the 2008 outcome. RESULTS   Using BoP≤20% as the cut-off, the relationship between BoP and interleukin-1 genotype status was neither significant in 2005 nor in 2008. Neither the high- nor low-risk group was predictive for tooth loss. Patients displayed similar proportions of probing pocket depths ≥6mm in 2005 and in 2008. Linear stepwise regression analysis demonstrated that only the number of supportive periodontal therapy visits explained the number of teeth lost due to periodontitis (P<0.01). CONCLUSIONS   The categorization of patients into high- and low-risk groups, according to the periodontal risk assessment model applied within a supportive periodontal therapy period of 3 years, had limitations in predicting future tooth loss.